HEALTH TRAIN EXPRESS
Follow or subscribe to Health Train Express as well as Digital Health Space for all the updates for health policy, reform, public health issues. Health Train Express is published several times a week.Subscribe and receive an email alert each time it is published. Health Train Express has been published since 2006.

Thursday, August 18, 2016

Unlike most government agencies the CDC (Communicable Diseases Center) enjoy some trust by the nation. The department of health and human services and CMS have shot themselves in the foot so many times, that few trust the overlying political exigencies affecting their day to day operation. Ultimately congress is responsible, however the messenger is always HHS. HHS does not make the rules....it carries out the congressional mandate and the people's will.

The public continues to express positive views of many agencies of the federal government, even though overall trust in government is near historic lows. In fact, favorable opinions surpass unfavorable views for seven of eight government agencies tested – the IRS is the lone exception. In a survey last February, however, just 24% said they could trust the government in Washington always or most of time. (See thisinteractivefor more on trust in government.)

The latest national survey by the Pew Research Center, conducted Jan. 7-11 among 1,504 adults, finds that 70% have a favorable view of the CDC, which came under criticism last fall for its handling of the outbreak of the Ebola virus. Nearly as many (68%) have a favorable view of NASA, and 65% hold a favorable view of the Department of Defense.

While overall favorable ratings for most of the agencies tested have changed little over time, there has been a sharp decline in positive views of the Department of Veterans Affairs (VA). Currently, 52% have a favorable view of the VA, down 16 points since October 2013. The agency has been widely faulted for delays in health care for veterans; the scandal led to the ouster last year of VA Secretary Eric Shinseki.

Wednesday, August 17, 2016

I once went out for a lunch buffet with an Indian doctor in Tennessee. I went to discuss some business related to practice management software. As we began to have our lunch, an young intern of his joined us. It was a big buffet. So, we had time to talk.

We discussed his practice, about ICD-9 to ICD-10 transition and his general state of affairs. He had been in business for more than a decade. So, he was quite well set. Coming from India, he talked about how he came to pursue this line of occupation rather than the Engineering line. It was not surprising considering that most of the Indians growing in the 80s and 90s mostly had the doctor (MBBS) or engineer (BTech) educations to choose from.

However, as we began to talk about the money part of his business, I sensed that things were not going that well as he would have wanted or as much as he had expected when he chose this profession. It was not because he was losing customers or that there was competition. He talked about how the government was making it hard for him to get paid. You see in the US, the health care insurance companies get into the act once a patient visits a doctor. They go through the due diligence procedures (Coding, billing, claims and whole9 yards) before the doctors and hospitals would get paid. The doctor talked about how delayed payments were upsetting his small practice. He grumbled about how it was no longer lucrative to be in this line of occupation. What’s more, he wouldn’t encourage his own children to purse it. I was surprised that he was that frank about it in front of his intern.

I think the hard times were speaking, but what really amazed me was what the doctor did next at the lunch table. As the waiter placed one more plate of the Indian Naan on the table, the doctor quickly covered it in the paper napkin and swiftly / secretly pushed it in his suitcase.It is not about beinglucrative, it is about sustainability and stability. The business model is changing from FFS to QUALY, using unproven metrics to measure performance and outcomes. Population management does not always translate to the individual patient sitting in front of the provider. It is all about regulating doctors, decreasing utilization and taking the health care dollars for Defense, Education,

Furthermore, our societies, such the AMA have abandoned us. I do not want those organizations speaking for me or you.They 'negotiate' to maintain some bizarre mindset that patients and providers are in control. Ask a patient if they are in control ?(10/1) Home - Quora

I once went out for a lunch buffet with an Indian doctor in Tennessee. I went to discuss some business related to practice management software. As we began to have our lunch, an young intern of his joined us. It was a big buffet. So, we had time to talk.

We discussed his practice, about ICD-9 to ICD-10 transition and his general state of affairs. He had been in business for more than a decade. So, he was quite well set. Coming from India, he talked about how he came to pursue this line of occupation rather than the Engineering line. It was not surprising considering that most of the Indians growing in the 80s and 90s mostly had the doctor (MBBS) or engineer (BTech) educations to choose from.

However, as we began to talk about the money part of his business, I sensed that things were not going that well as he would have wanted or as much as he had expected when he chose this profession. It was not because he was losing customers or that there was competition. He talked about how the government was making it hard for him to get paid. You see in the US, the health care insurance companies get into the act once a patient visits a doctor. They go through the due diligence procedures (Coding, billing, claims and whole9 yards) before the doctors and hospitals would get paid. The doctor talked about how delayed payments were upsetting his small practice. He grumbled about how it was no longer lucrative to be in this line of occupation. What’s more, he wouldn’t encourage his own children to purse it. I was surprised that he was that frank about it in front of his intern.

I think the hard times were speaking, but what really amazed me was what the doctor did next at the lunch table. As the waiter placed one more plate of the Indian Naan on the table, the doctor quickly covered it in the paper napkin and swiftly / secretly pushed it in his suitcase.It is not about beinglucrative, it is about sustainability and stability. The business model is changing from FFS to QUALY, using unproven metrics to measure performance and outcomes. Population management does not always translate to the individual patient sitting in front of the provider. It is all about regulating doctors, decreasing utilization and taking the health care dollars for Defense, Education,

Furthermore, our societies, such the AMA have abandoned us. I do not want those organizations speaking for me or you.They 'negotiate' to maintain some bizarre mindset that patients and providers are in control. Ask a patient if they are in control ?(10/1) Home - Quora

Tuesday, August 16, 2016

Health Train Express has been away for part of the summer, and there is much news to report.

It is that time of the year for insect repellent. And not just for ridding the pesky evening bugs and annoying bites that ruin summer picnics, baseball games and outdoor sporting events

During the summer an airborne force in the sky (the mosquito) carries multiple threat weapons, guided by heat seeking, carbon dioxide homing missiles. The onslaught is continuous and each season begins again as reported by the World Health Organization. With modern prevention measures large epidemics are not prevalent. Our air defense system of mosquito control, repellents and treatment for the diseases is vastly improved.

Mosquito-borne diseases

Mosquitoes cause millions of deaths every yearThese tiny predators go after targets much larger than themselves. Many years ago scientists revealed the deadly tropical diseases spread by these vectors. Controlling these diseases depended upon destroying the vector mosquitos.
Here are some of the villains:

The virus is transmitted from human to human by the bites of infected female mosquitoes. Most commonly, the mosquitoes involved are Aedes aegypti and Aedes albopictus, two species which can also transmit other mosquito-borne viruses, including dengue.

Human infection is most often the result of bites from infected mosquitoes. Mosquitoes become infected when they feed on infected birds, which circulate the virus in their blood for a few days. The virus may also be transmitted through contact with other infected animals, their blood, or other tissues.

A very small proportion of human infections have occurred through organ transplant, blood transfusions and breast milk. There is one reported case of trans placental (mother-to-child) WNV transmission.

To date, no human-to-human transmission of WNV through casual contact has been documented,

In most cases, malaria is transmitted through the bites of female Anophelesmosquitoes. There are more than 400 different species of Anopheles mosquito; around 30 are malaria vectors of major importance. Unlike Yellow Fever, Dengue, Chikungunya and West Nile Virus the pathogen is not a virus, but a parasite, P. falciparum .

Treatment

Good and early supportive treatment in hospitals improves survival rates. There is currently no specific anti-viral drug for yellow fever but specific care to treat dehydration, liver and kidney failure, and fever improves outcomes. Associated bacterial infections can be treated with antibiotics.

Prevention

1. Vaccination

Vaccination is the most important means of preventing yellow fever. In high-risk areas where vaccination coverage is low, prompt recognition and control of outbreaks using mass immunization is critical for preventing epidemics. It is important to vaccinate most (80 % or more) of the population at risk to prevent transmission in a region with a yellow fever outbreak.

Zika virus is primarily transmitted to people through the bite of an infected mosquito from the Aedes genus, mainly Aedes aegypti in tropical regions. Aedes mosquitoes usually bite during the day, peaking during early morning and late afternoon/evening. This is the same mosquito that transmits dengue, chikungunya and yellow fever. Sexual transmission of Zika virus is also possible. Other modes of transmission such as blood transfusion are being investigated.

Can human emotion, and/or cognitive thinking be distilled into a science? The past three decades have advanced our understanding of what emotions and thoughts are biochemically.Our knowledge of how we think and how we feel is being distilled into basic science. New imaging techniques now allow scientists to see what is happening when and where in our brain in real-time. We have discovered the brain has certain regenerative capability by it's redundancy, much like a backup of your computer's hard drive. The brain's inherent 'intelligence' allows it to 'rewire' it's neuronal network, allowing for different regions of the brain to alter function. Neural plasticity allows for these amazing changes. In the near future a combinaton of behavioral training and neuropharmacology will be the future of treatment for neurolgic treatment. The 'black hole of the brain may be coming to an end.﻿When and where do sentience reside ? Is it a place in our brain? (the capacity to feel, perceive, or experience subjectively.[1] Eighteenth-century philosophers used the concept to distinguish the ability to think (reason) from the ability to feel (sentience). In modern Western philosophy, sentience is the ability to experience sensations (known in philosophy of mind as "qualia") Does self awareness require sentience, or do they go hand-in-had?

The answers to these questions and others may come soon with tools such as fMRI new advances in high power microscopy, optogenetics and public involvement.

Wednesday, August 3, 2016

Senior citizens need more medical care than anyone else in the United States. And the Internet is chock full of health information. Yet seniors are far less likely than other adults to tap into it, new research shows.

That pales in comparison with the approximately 60% of adults of all ages who have told the Pew Research Center that they consult Dr. Google at least once a year -- including the 35% who said they rely on the Web to diagnose their own ailments or the maladies of people they know.

Since 2011, thousands of Medicare beneficiaries in the aging trends study have been completing annual surveys that gauge their use of technology. In the survey’s first year, 64% of the survey takers had computers and 43% were hooked up to the Internet. Their average age was 75.

Among all 7,609 initial study participants, only 16% said they went online to learn something about health. In addition, 8% said they filled prescriptions online, 7% used the Internet to get in touch with their doctors and 5% dealt with their insurance claims on the Web.

Altogether, 21% of seniors who were surveyed in 2011 used the Internet for at least one of these four health-related tasks, according to the JAMA report. By 2014, that figure rose to 25% — a small yet statistically significant increase, the study authors wrote.

Some senior citizens were more likely to go online for health-related reasons than others. For instance, the odds were twice as high for white seniors than for their black and Latino counterparts. College graduates were seven times more likely to handle health issues online than were seniors who didn’t finish high school. Seniors who rated their own medical condition as “excellent” were twice as likely to boot up their computers for the sake of their health than were seniors who rated their medical condition as “poor.”

Apparently, these seniors had better things to do than research ways to prevent heart disease, manage symptoms of diabetes or stave off dementia. Email was far more enticing. Electronic banking (but not online shopping) was also more popular.

Apparently, these seniors had better things to do than research ways to prevent heart disease, manage symptoms of diabetes or stave off dementia. Email was far more enticing. Electronic banking (but not online shopping) was also more popular.

“Digital health is not reaching most seniors,” wrote the authors, all from Brigham and Women’s Hospital in Boston. That means the Internet isn’t living up to its potential as a tool to “improve quality, cost, and safety of their health care.”

And perhaps that may not be a bad thing.

But perhaps seniors are right to eschew the health information available online. A 2014study in the Journal of the American Osteopathic Assn. found that Wikipedia entries for nine common health conditions -- coronary artery disease, lung cancer, major depressive disorder, osteoarthritis, chronic obstructive pulmonary disease, high blood pressure, diabetes, back pain and high cholesterol -- contained a significant amount of information that was at odds with the latest medical research.

Monday, August 1, 2016

Hype plays a large role in media publications. Perhaps well intentioned, but often written to attract more readership by an unsophisticated readership. The front counters of grocery checkout stands share space with The Enquirer, The Hollywood Reporter, People Magazine, or Popular Science about what is 'gossip' in the health science space.

Large multi-billion dollar companies purchase smaller competitors to kidnap intellectual property, hire scientific luminaries and inventors with what they consider to be petty cash from their vaults of gold and greenbacks. Money is seductive....even to reputable scientists and especially to inventors and entrepenurs anxious to capitalize on the singularity of exponential growth in health technology. To lose out on a possible chance of success (even if the odds are 1 our of ten or even 1 out of 1000 would appear foolhardy when the stakes are so high and the rewards in virtual wealth are just that....virtual (not real).

A new term I shall coin is 'virtual estate'...the polar opposite of 'real estate'. During the time when our economy and real estate values crashed, Virtual estate thrived.

Runaway (not to be considered a bad thing) fuels rapid advances and also has a high failure rate.

Disclaimer

The opinions in this blog or other forms of social media are solely that of Gary M. Levin M.D. Dr. Levin has no financial interests in any medical devices which are discussed or which appear in the blog. Commentary taken from other sources are either quoted or referenced with attribution. Dr Levin does not endorse, nor give financial support to any political organizations.